The percentage of VA patients with at least one instance of concurrent eGFR and serum creatinine reported reached the highest in 2016 (≥ 97%).
Chart Explanation: For the data available, a majority of patients had at least one incidence of eGFR coreporting with their serum creatinine result. In total, reporting of eGFR with serum creatinine results is increasing over time.
The Veteran’s Affairs (VA) data presented are from a national sample of health care visits to the VA Health System by eligible U. S. veterans. During any given year, ~ 70% of the outpatient population receives a serum creatinine test. While the demographics of VA Health System users are distinct from the general U.S. population, the VA data allow a ‘snapshot’ of clinical practices across the nation.
National VA data were examined for veterans with at least one outpatient visit during the federal fiscal year. To estimate prevalence of CKD, outpatient serum creatinine laboratory results (averaged if a patient had more than one test during the fiscal year) were used to calculate an estimated glomerular filtration rate (eGFR) for each patient using the CKD-EPI equation, excluding dialysis and transplant patients. Estimated GFR (kidney function) was classified into five CKD categories (eGFR =90, eGFR 60-89, stage 3=eGFR 30-59, stage 4=eGFR 15 to 29, and stage 5 without dialysis=eGFR<15 ml/min/1.73 m² and “eGFR Unmeasured” for those patients without serum creatinine testing. Inpatient serum creatinine data were not used as they would be affected by the presence of acute illnesses. Due to the infrequency of testing, albuminuria was not included in the definition of CKD. Dialysis patients were defined by clinic stop-codes (602-611), outpatient procedure codes for dialysis (CPT4: 90921 and 90925), outpatient diagnosis codes (ICD-9-CM: 585.6, V56, V45.1 and E87.91 and ICD-10-CM: N186, Y841, Z4931, Z4901, Z4902, Z4931, Z4932, and Z4933) to indicate dialysis. Kidney transplant patients were identified by inpatient and outpatient ICD-9-CM diagnosis code V420, 99681, ICD-10 CM diagnosis code T86X, Z4822 and Z940, and inpatient procedure and surgery codes (55.69)
Because changes in serum creatinine values alone can be misleading when predicting significant changes in renal function, NKDEP strongly encourages clinical laboratories to report (or coreport) an estimated glomerular filtration rate (eGFR) with serum creatinine values. In the VA health care system, coreporting serum creatinine and eGFR began in 2003-2004. Clinical laboratories using creatinine methods not calibrated to be traceable tothe isotope dilution mass spectrometry (IDMS) method were encouraged to use the original MDRD study equation, while laboratories using IDMS-calibrated creatinine methods were encouraged to use the IDMS-traceable MDRD study equation. The eGFR reporting data has been available in research data files starting in 2006 at VA.
This material is the result of work supported with resources and the use of facilities at the Veterans Affairs Ann Arbor Health Care System, Ann Arbor, Michigan.
|Description of Measure||Laboratory Reporting of eGFR|
|Type of Data Source||Administrative|
|Data Set||VA National Data, using the MedSAS data files|
|Health Care System Data||Yes|
|Regional or National?||National|
|Demographic Group||Patients in VA health system|
|Numerator (1)||Adults in the denominator with at least one reported eGFR value.|
|Denominator (1)||Adults (≥ 20 years) with at least one serum creatinine lab result during the fiscal year|
|Primary Data Source Indicator||Serum Creatinine and eGFR Lab Results|
|Primary Indicator Method of Measurement||Laboratory|
|Period Currently Available||2018|
|Analytical Considerations||No standard reporting format within the VA laboratories: 98% of eGFR results were reported as a value; 2% were reported as a range (e.g.“> 60 ml/min/1.73 m²” or “> 89 ml/min/1.73 m²”) in 2008.|